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Issue

Vol 123 No 1316: 11 June 2010

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Issue Summary

SUMMARY

Illness severity scoring for Intensive Care at Middlemore Hospital, New Zealand: past and future

Susan L Mann, Mark R Marshall, Alec Holt, Brendon Woodford, Anthony B Williams

Scoring systems are one of the tools used in intensive care to allow study of progress in medical techniques and treatment over time. Middlemore Hospital caters for a unique population, and this is reflected in the diverse nature of admissions to our intensive care unit. Until recently, we have relied upon an international gold-standard scoring system to help us benchmark the outcomes we are achieving in our intensive care unit. In this study we show how this scoring system has become less helpful over time. We suggest some new approaches that might provide a more realistic reflection of practice and outcomes in our population.

SUMMARY

Capturing outcomes following injury: a New Zealand pilot study

Sarah Derrett, Gabrielle Davie, Shanthi Ameratunga, John Langley

To identify ways of improving outcomes after injury we need to know what promotes good outcomes and reduces poor outcomes. Few studies have followed the impact of injury on individual New Zealanders over time. We were unsure if injured New Zealanders would be willing to take part in a study of outcome following injury if the initial invitation came from their insurerthe ACC. Two-thirds of eligible people contacted were willing to take part in a pilot study and participants included those with a range of injury types and causes. Following the pilot study, improvements were made to the main Prospective Outcomes of Injury Study which is now underway.

SUMMARY

Preventability of pre-hospital trauma deaths in southern New Zealand

James A Falconer

This study was done on the pre-hospital preventability of trauma deaths in New Zealand as no similar study has been done despite trauma being a leading cause of death in this country. Post-mortem reports were examined and scored with a well recognised scoring system to determine preventability of the deaths in the study region (Otago and Southland from 2000 to 2004). Most of the study population was found to have multiple anatomical regions injured, with the head and chest the most frequently fatally injured regions. Most deaths were in males under the age of 35, and the majority of the study population died as a result of motor vehicle accidents. The majority of the study population had non-survivable injuries however nearly half (45%) had either survivable (10%) or potentially survivable injuries (35%). This is similar to other comparable international studies.

SUMMARY

Intensive care triage in Australia and New Zealand

Paul J Young, Richard Arnold

We conducted a web-based survey of Australian and New Zealand intensive care doctors measuring demographics, details of recent triage decisions and attitudes towards various triage scenarios. This survey demonstrated that there are significant differences between the views of intensive care practitioners in Australia and those in New Zealand with respect to a range of common intensive care triage scenarios with those in New Zealand tending to be more selective in their admission criteria. Despite these differences, we did not demonstrate any difference in the proportion of referrals to the intensive care unit that were refused.

SUMMARY

Unintentional falls at home among young and middle-aged New Zealanders resulting in hospital admission or death: context and characteristics

Bridget Kool, Shanthi Ameratunga, Wayne Hazell, Alex Ng

This study describes the characteristics and contexts of unintentional falls at home among adults aged 25-59 years that resulted in admission to hospital or death during a 12-month period in Auckland, New Zealand. Of the 335 people who fell during the 12 month period and agreed to be interviewed (in the case of death or major injury a family member was interviewed), 36% fell on stairs/steps, 31% fell on the same level, 13% of falls involved ladders or scaffolding, and 11% fell from buildings or structures. The majority of falls (81%) occurred in the individuals own home. While this analysis was not designed to identify the specific causes of falls, 24% of participants had consumed 22652 drinks in the 6-hours preceding the fall, and 24% were on 22652 prescription medications. The findings reveal several important contextual factors that can be targeted to prevent fatal and serious non-fatal falls at home among this age group.

SUMMARY

Ethnicity of severe trauma patients: results of a population-based study, Auckland, New Zealand 2004

Gowan Creamer, Ian Civil, Alex Ng, David Adams, Shas 010ca 010dala , Timothy Koelmeyer, John Thompson

Ethnicity is a factor in severe injury and mortality (death) rates in Auckland. Our study findings show that M ori and Pacific people had increased risk of severe injury and injury-related mortality in 2004.

SUMMARY

Patterns of lower limb fractures sustained during snowsports in Otago, New Zealand

Alistair Patton, Jim Bourne, Jean-Claude Theis

We describe the nature and circumstances of leg fractures sustained during skiing and snowboarding, that required operative fixation at a single orthopaedic unit in New Zealand from 2002 to 2008.

ALL ARTICLES
SUMMARY

Foreign bodies do strange things: the case of a shard of glass in the scapulo-thoracic space

Georgette Oni, Nitin Vaingankar

Medical education to improve Māori health

Rhys Jones, Suzanne Pitama, Tania Huria, Phillippa Poole, Judy McKimm, Ralph Pinnock, Papaarangi Reid

Illness severity scoring for Intensive Care at Middlemore Hospital, New Zealand: past and future

Susan L Mann, Mark R Marshall, Alec Holt, Brendon Woodford, Anthony B Williams

Capturing outcomes following injury: a New Zealand pilot study

Sarah Derrett, Gabrielle Davie, Shanthi Ameratunga, John Langley

The future of acute care in New Zealand

Peter Freeman, Tim Parke

Preventability of pre-hospital trauma deaths in southern New Zealand

James A Falconer

Intensive care triage in Australia and New Zealand

Paul J Young, Richard Arnold

Unintentional falls at home among young and middle-aged New Zealanders resulting in hospital admission or death: context and characteristics

Bridget Kool, Shanthi Ameratunga, Wayne Hazell, Alex Ng

Notice to correspondents

High support for a tobacco endgame by Pacific peoples who smoke: national survey data

Nick Wilson, Richard Edwards, George Thomson, Deepa Weerasekera, Api Talemaitoga

Response to In search of professionalism" article"

MAH (Tony) Baird

University of Otago Faculty of Medicine Freemasons Postgraduate Fellowships in Paediatrics and Child Health for 2011

Response to former HDC’s editorial “Lessons from complaints”

Denys Court

Selenium and ocular health in New Zealand

Leo Sheck, Jo Davies, Graham Wilson

Party pill' drugs—BZP and TFMPP (Ustana Antia, Malcolm D Tingle, Bruce R Russell)

How to achieve New Zealand’s shorter stays in emergency departments health target

Mike Ardagh

Backlash follows chiropractors' attempts to suppress scientific debate

Shaun Holt, Andrew Gilbey

Ethnicity of severe trauma patients: results of a population-based study, Auckland, New Zealand 2004

Gowan Creamer, Ian Civil, Alex Ng, David Adams, Shas 010ca 010dala , Timothy Koelmeyer, John Thompson

High pressure injection of silica-based paint into a finger

Jason Locker, Alan Carstens

Patterns of lower limb fractures sustained during snowsports in Otago, New Zealand

Alistair Patton, Jim Bourne, Jean-Claude Theis

A national trauma network: now or never for New Zealand

Ian Civil

Jessie Christine Anderson

Medical image. A thump and an expanding lump

Manar Khashram, Christopher M Holdaway

SUMMARY

Illness severity scoring for Intensive Care at Middlemore Hospital, New Zealand: past and future

Susan L Mann, Mark R Marshall, Alec Holt, Brendon Woodford, Anthony B Williams

Scoring systems are one of the tools used in intensive care to allow study of progress in medical techniques and treatment over time. Middlemore Hospital caters for a unique population, and this is reflected in the diverse nature of admissions to our intensive care unit. Until recently, we have relied upon an international gold-standard scoring system to help us benchmark the outcomes we are achieving in our intensive care unit. In this study we show how this scoring system has become less helpful over time. We suggest some new approaches that might provide a more realistic reflection of practice and outcomes in our population.

SUMMARY

Capturing outcomes following injury: a New Zealand pilot study

Sarah Derrett, Gabrielle Davie, Shanthi Ameratunga, John Langley

To identify ways of improving outcomes after injury we need to know what promotes good outcomes and reduces poor outcomes. Few studies have followed the impact of injury on individual New Zealanders over time. We were unsure if injured New Zealanders would be willing to take part in a study of outcome following injury if the initial invitation came from their insurerthe ACC. Two-thirds of eligible people contacted were willing to take part in a pilot study and participants included those with a range of injury types and causes. Following the pilot study, improvements were made to the main Prospective Outcomes of Injury Study which is now underway.

SUMMARY

Preventability of pre-hospital trauma deaths in southern New Zealand

James A Falconer

This study was done on the pre-hospital preventability of trauma deaths in New Zealand as no similar study has been done despite trauma being a leading cause of death in this country. Post-mortem reports were examined and scored with a well recognised scoring system to determine preventability of the deaths in the study region (Otago and Southland from 2000 to 2004). Most of the study population was found to have multiple anatomical regions injured, with the head and chest the most frequently fatally injured regions. Most deaths were in males under the age of 35, and the majority of the study population died as a result of motor vehicle accidents. The majority of the study population had non-survivable injuries however nearly half (45%) had either survivable (10%) or potentially survivable injuries (35%). This is similar to other comparable international studies.

SUMMARY

Intensive care triage in Australia and New Zealand

Paul J Young, Richard Arnold

We conducted a web-based survey of Australian and New Zealand intensive care doctors measuring demographics, details of recent triage decisions and attitudes towards various triage scenarios. This survey demonstrated that there are significant differences between the views of intensive care practitioners in Australia and those in New Zealand with respect to a range of common intensive care triage scenarios with those in New Zealand tending to be more selective in their admission criteria. Despite these differences, we did not demonstrate any difference in the proportion of referrals to the intensive care unit that were refused.

SUMMARY

Unintentional falls at home among young and middle-aged New Zealanders resulting in hospital admission or death: context and characteristics

Bridget Kool, Shanthi Ameratunga, Wayne Hazell, Alex Ng

This study describes the characteristics and contexts of unintentional falls at home among adults aged 25-59 years that resulted in admission to hospital or death during a 12-month period in Auckland, New Zealand. Of the 335 people who fell during the 12 month period and agreed to be interviewed (in the case of death or major injury a family member was interviewed), 36% fell on stairs/steps, 31% fell on the same level, 13% of falls involved ladders or scaffolding, and 11% fell from buildings or structures. The majority of falls (81%) occurred in the individuals own home. While this analysis was not designed to identify the specific causes of falls, 24% of participants had consumed 22652 drinks in the 6-hours preceding the fall, and 24% were on 22652 prescription medications. The findings reveal several important contextual factors that can be targeted to prevent fatal and serious non-fatal falls at home among this age group.

SUMMARY

Ethnicity of severe trauma patients: results of a population-based study, Auckland, New Zealand 2004

Gowan Creamer, Ian Civil, Alex Ng, David Adams, Shas 010ca 010dala , Timothy Koelmeyer, John Thompson

Ethnicity is a factor in severe injury and mortality (death) rates in Auckland. Our study findings show that M ori and Pacific people had increased risk of severe injury and injury-related mortality in 2004.

SUMMARY

Patterns of lower limb fractures sustained during snowsports in Otago, New Zealand

Alistair Patton, Jim Bourne, Jean-Claude Theis

We describe the nature and circumstances of leg fractures sustained during skiing and snowboarding, that required operative fixation at a single orthopaedic unit in New Zealand from 2002 to 2008.

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